Echinoderm Envenomation Workup

  • Author: Scott A Gallagher, MD, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jan 11, 2011
 

Laboratory Studies

No specific laboratory tests are indicated in the management of echinoderm envenomations; however, in cases of severe systemic symptoms (eg, hypotension, paralysis, respiratory failure), a complete workup to exclude other etiologies may be warranted.

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Imaging Studies

Soft tissue radiographs are indicated as the initial study modality when attempting to exclude retained foreign bodies. Most calcareous spines are visualized either directly or indirectly with the use of radiographs. Nonradiodense objects can be revealed as filling defects or outlined by air drawn into the wound during the injury.

If an object cannot be visualized by plain radiography or retrieved easily through direct visualization, ultrasound may be used. Ultrasound can detect nonradiodense foreign bodies as small as 1 X 2 mm and can be used to accurately localize foreign material and provide guidance during removal. Tendons, deep scar tissue, fresh hematoma, and tissue calcifications can produce false-positive ultrasound readings. Ultrasonography requires experience and skill to maximize its usefulness.

Computed tomography (CT) scans and magnetic resonance imaging (MRI) are expensive alternatives to ultrasound that can identify and precisely localize retained foreign material. Both require a high degree of patient cooperation and may be difficult to perform on pediatric patients.

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Procedures

Ocular exposure to holothurin toxins and tentacular fragments following exposure to the organs of Cuvier of sea cucumbers requires a thorough slit lamp examination for retained foreign bodies and evidence of corneal abrasion or keratitis.

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Contributor Information and Disclosures
Author

Scott A Gallagher, MD, FACEP  Department of Emergency Medicine, Aspen Valley Hospital; Senior Clinical Instructor, Department of Surgery, School of Medicine, University of Colorado Health Sciences Center

Scott A Gallagher, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert L Norris, MD  Professor, Department of Surgery, Chief, Division of Emergency Medicine, Stanford University Medical Center

Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, California Medical Association, International Society of Toxinology, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

James Steven Walker, DO, MS  Clinical Professor of Surgery, Department of Surgery, University of Oklahoma College of Medicine

James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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Echinoderm envenomations. Close-up of brittle star arm. Although spiny, members belonging to this class (Ophiuroidea) generally are considered harmless. Of the phylum Echinodermata, only starfish (class Asteroidea), sea urchins (class Echinoidea), and sea cucumbers (class Holothuroidea) are capable of envenomation. Photo courtesy of Scott A. Gallagher, MD.
Echinoderm envenomations. Unlike most starfish that are typically pentamerous, the crown-of-thorns starfish (Acanthaster planci) may have as many as 23 arms and a body disc up to 60 cm in diameter. Photo courtesy of Dee Scarr.
Echinoderm envenomations. Detail of the crown-of-thorns starfish (Acanthaster planci) spines, which may grow to 6 cm in length. Photo courtesy of Dee Scarr.
Echinoderm envenomations. Detail of the crown-of-thorns starfish (Acanthaster planci). Photo courtesy of Scott A. Gallagher, MD.
Echinoderm envenomations. The common and toxic sea cucumber, Bohadschia argus, with extruded Cuvierian tubules. Contact with these sticky white tentaclelike organs or their free-floating fragments may result in intense skin or ocular irritation. Photo courtesy of Paul S. Auerbach, MD.
Echinoderm envenomations. Long-spined sea urchins, such as this Diadema species, inflict an acutely painful penetrating injury that may be accompanied by systemic symptoms and chronic wound sequelae. Photo courtesy of Dee Scarr.
 
 
 
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